Method and device for securing sutures to bones

ABSTRACT

A method, system and device for securing a repair, such as a rotator cuff repair and includes an anchor placed within a hole formed in bone and a cannulated screw inserted into the hole after the anchor has been inserted to effectuate a firm and secure connection of tissue to bone, particularly when the quality of the bone does not permit optimal fixation. The method, system and device allows superior tissue fixation to bone with the ease of knotless suture anchor application.

CROSS-REFERENCE TO RELATED APPLICATION

The present application claims the benefit of U.S. Provisional Patent Application Ser. No. 61/071,568, filed On May 6, 2008. The subject matter of the provisional patent application is incorporated by reference herewith.

BACKGROUND OF THE INVENTION

During surgery, anchors have been used with sutures to reattach tissue to bone. The anchors have been inserted into holes that have been pre-drilled. Difficulties arise when the anchor has been inserted and is not flush with the top of the bone mass. Additionally, the anchor has been known to move or adjust thereby jeopardizing a secure repair.

SUMMARY OF THE INVENTION

Part of a successful surgery to reconnect tissue to bone requires that sutures firmly secure the tissue to the bone. It is important that the repair have long term stability. The disclosed method, system and device for securing the repair includes an anchor placed within a pre-drilled hole formed in bone and a cannulated screw inserted into the hole after the anchor, and holding same in place, to effectuate a firm and secure connection of tissue to bone, particularly when the quality of the bone does not permit optimal fixation. The method, system and device allows superior screw in fixation with the ease of knotless suture anchor application.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 a is a view of a cannulated screw used with the system and method;

FIGS. 1 b-1 f depict steps of the repair;

FIGS. 2 a and 2 b show different types of anchors used with a multirow repair;

FIG. 3 is a view of the inserter rod, screw and anchor;

FIGS. 4 a-4 h depict the method in a single row rotator cuff repair; and

FIGS. 5 a-5 i depict the system and method in a double row rotator cuff repair.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 a shows the cannulated fastener, such as a cannulated bone screw 10 having a central bore 12 extending the entire length of the screw, allowing the screw to move along a bone anchor inserter rod. The fastener may be made of any suitable material, including bioabsorbable material, and may be a barbed fastener which is driven into a bone hole, rather than screwed. The fastener that is inserted need only have a flattened distal aspect to block the fixation anchor from migrating. In FIG. 1 b, an anchor 14 has been inserted within a hole 16 in a bone 18. The anchor has a suture loop 20, either fixed or adjustable in length, passing through tissue 22, such as a rotator cuff, to secure the tissue 22 to the bone 18. The anchor has captured the loop, allowing for fixation without needing to tie a knot. As can be seen, there is a distance between the top of the anchor and the top of the opening in the bone. This distance can be measured by markings 25 along the inserter rod 24 seen in FIG. 1 c. In FIG. 1 d, the cannulated screw 10 is movable along the inserter rod 24, as is the cannulated screw driver 26. The screw driver 26 allows the screw 10 to be driven into the bone hole 16 as the end of the screw driver engages the head of the screw to rotate the screw. FIG. 1 e shows the screw 10 having been successfully driven into the hole and now on top of the bone anchor 14 to prevent the anchor's movement. Having been successfully accomplished, the inserter rod 24 is removed as seen in FIG. 1 f. The standard knotless anchor inserter rod is modified to have a reverse threaded tab 27. This enables the tab to be removed without removing the inserter rod from the anchor.

FIGS. 2 a and 2 b depict just one of the many types of bone anchors 30 that may be used with a double row repair. The bone anchor may accommodate one or multiple suture loops 32 which may be either of fixed or adjustable length. Utility sutures 34 extend from the suture loops. FIG. 3 shows the entire assembly of the inserter rod 24, a bone anchor 14 such as a knotless bone anchor and a cannulated screw 10 and screw driver 26 placed over and movable along the inserter rod.

FIGS. 4 a-4 h depict a single row rotator cuff repair. A lateral hole 16 is made, by either drilling, or is produced with an awl-like device 36, in the bone 18, as shown in FIG. 4 a and a suture 20 is passed through the tissue 22. The suture 20 is captured by the bone anchor 14, as seen in FIGS. 4 b and 4 c. The anchor 14 is inserted to the appropriate depth 16 and the suture loop is tightened in order to approximate the tissue to the repair site. The loop need not be tightened when the loop is of a fixed length. Once the anchor 14 is successfully seated within the hole, the screw 10 is advanced along the inserter rod 24 and driven into the hole by the cannulated screw driver 26 as seen in FIG. 4 f. Once successfully inserted, the inserter rod 24 is removed and the repair is complete as seen in FIG. 4 g. FIG. 4 h shows a completed two anchor repair.

FIGS. 5 a-5 i depict a double row repair with a spiral bone anchor 30 with attached suture loop(s) 32, such as the anchors seen in FIGS. 2 a and 2 b, driven into a first hole 38. The suture passes through tissue 22 and is captured by the bone anchor 14 as seen in FIG. 5 d. At this point, the anchor 14 is set within the second hole 16, followed by the setting of the bone screw 10 in a manner described earlier with reference to the single row repair. The completed multiple row repair is depicted in FIG. 5 i.

The method can be applied to any repair requiring tissue to be reattached to bone. Further, the bone anchor, or cannulated bone screw can be made of any desirable material and may be of bioabsorbable or bioreplaceable material. Either implanted device may change over time. 

1. A cannulated bone screw comprising a central bore extending an entire length of the screw and having a flat distal end for engaging a fixation anchor and preventing movement thereof.
 2. The cannulated bone screw of claim 1, further comprising a screw pattern on its exterior for secure engagement with a bone mass.
 3. The cannulated bone screw of claim 1, wherein the bone screw is made of a bioabsorbable or bioreplaceable material.
 4. A method of firmly securing tissue to a bone mass comprising the steps of: a) drilling or punching a hole in the bone mass; b) inserting a fixation anchor, having at least one suture element attached thereto, into the hole, thereby drawing tissue that has been secured by the at least one suture, into secure attachment with the bone mass; and c) inserting a cannulated bone screw into the hole to prevent movement of the anchor.
 5. The method of claim 5, wherein the cannulated bone screw is screwed into the hole for secure engagement.
 6. The method of claim 4, wherein the anchor and the screw are both inserted by an inserter rod which passes through the cannulated bone screw and inserts the anchor into the hole drilled in the bone mass.
 7. The method of claim 4, wherein the suture element is captured by the anchor during the anchor's insertion into the hole.
 8. The method of claim 6, wherein the inserter rod has markings to measure the distance the anchor has been inserted into the bone mass and allow for correctly sizing of a length of the screw.
 9. The method of claim 6, wherein the inserter rod is removed once the screw has been placed into secure engagement with the anchor.
 10. The method of claim 4, wherein the suture element is first inserted via a screw anchor into the bone mass; the suture is passed through the tissue element and then captured by an anchor for insertion into the hole.
 11. The method of claim 10, wherein the screw anchor has one or more suture loops attached thereto.
 12. The method of claim 4, wherein the anchor has at least one adjustable length suture loop attached thereto.
 13. The method of claim 12, wherein the at least one adjustable length suture loop is adjustable using a sliding, self-locking knot. 